He had always been aggressive and had been hospitalized numerous times.  His anger was uncontrollable. Medications were no use and therapy had not proved helpful. He was large, strong, determined, and would attack anyone, even his mother. She had grown to fear him.  When home with him, she never knew what he would do.  Would he attack her children? Would he break things, throw things, and punch more holes in the wall?  Sometimes he would stay out all night and the police couldn’t find him.  She would fear for his life or the life of anyone he met.  But, he knew the streets and was not afraid, and that was part of the problem.  He was not afraid of anything – not the hospital, not jail, not the police.  She had called the police before but as he got older and stronger and smarter he was becoming more dangerous.  She did not know what to do.

He was nine years old.

George, we will call him, was originally diagnosed with ADHD and was sent to me for treatment.  He was a third grader and was large for his age, obese in fact. He was very smart and would help other students with their work in class. When he wasn’t out of his seat helping other students he might be throwing things, turning over tables, wreaking havoc in the classroom.

This was a good way to get attention but that did not explain his behavior because George had positive ways of gaining attention.  He was funny, smart, and charming.  Still, his mother bought a special lock to keep him locked in and safe but he discovered how to pick it. He seemed to enjoy using his intellect to do bad things and nobody could tell when he would explode. The week before, when the psychiatrist was interviewing him after another hospitalization for aggressiveness, George suddenly jumped out of his seat, grabbed for the candy the good doctor was holding, and began to choke him.  The doctor, in shock, was stunned into a state of temporary paralysis.  He later explained that he knew the boy choking him was only nine-years old, but he couldn’t breathe, so he had to defend himself.  Had George been an adult in the street he would have responded more aggressively.  The doctor’s reaction was similar to many people’s reaction to George.  He was furious.

The earlier working diagnosis of ADHD was obviously incorrect and the second diagnosis of Oppositional Defiant Disorder was incorrect as well.  George was not just verbally oppositional.  He was also violent.  By the time a child is nine-years old they are aware that physically hurting other people is socially unacceptable.  If they feel no remorse afterwards it can be a sign that they have no empathy.  His mother said that he never apologized.  He never had manic states or was a slave to uncontrollable emotional swings.  George was not psychotic, did not hear voices, and was in no way divorced from reality. Even when in a rage, George never lost control of his rational faculties.  He didn’t blank out or dissociate.  He just didn’t care and he didn’t care what happened to him.  A child like that is dangerous to himself because one day he will attack someone who will not be a child psychiatrist.

George’s diagnosis now changed from ADHD and Oppositional Defiant Disorder to “Conduct Disorder – early onset.”  Conduct Disorder is a disorder usually reserved for teenagers and is usually not diagnosed before the age of 16.  These adolescents used to be referred to as juvenile delinquents.  They steal cars, rob, destroy property and hurt people. As they get older, particularly boys, the type of damage they inflict becomes worse.  If as adults they continue this pattern of anti-social behavior they are classified as having Anti-Social Personality Disorder and can end up in jail or dead.

George’s father once proudly remarked that he had been shot seven times at once and lived. Some of the bullets were still inside his body. He tried to give me advice as to how to deal with George’s behavior. “Let him do what he wants,” he said. 

After meeting the father, I met with George’s mother. She had an intuitive sense of George and could describe his behavior in great detail and how his mind worked.  She understood his motivations and told me numerous times that he was very smart and not at all crazy.  Unlike his father and grandmother, she was the only family member that tried to give George rules and structure.  One day on the train, when everything was peaceful and the outing with his mother and brother had been going just fine, he thanked her by punching her in the back with a closed fist. 

This level of aggression reminded me of George’s father, whose comfort with violence made an impression on me. After meeting him, I thought I had found George’s inspiration, his muse.  George’s mother would surely know.  So, I asked her:

“Who does George remind you of?”

“Me,” she said.

“You?’ I asked, “not his father?”

“Oh no’, she said, “me. You didn’t know me when I was younger.” 

Some people think anti-social behavior is triggered by an external or internal event.  That is not always the case.  My experience working with anti-social people has shown me that these individuals do not need a trigger. If there is no trigger available, they will invent one.  Freud wrote that without socialization, which entails putting in place behavior control mechanisms such as guilt, remorse, and shame, people would do as they please.  But, we pay an emotional price for being civilized. That price is the unpleasant experience most of us feel before or after we hurt others.  Some people do not have these internal controls and no medication or therapy can create them.  There is no medication for Oppositional Defiant Disorder, Conduct Disorder, or Anti-Social Personality Disorder. They all reflect the same negative stance toward civil behavior, but at different stages of life.   

Like Freud, Willy Wonka understood human nature well.  The Candy Man placed children into their own Garden of Eden – a world of chocolate and candy and color.  All he asked was that they respect the garden and his factory. Most of the children failed.  Augustus jumped into the chocolate river for a swim and polluted it. Violet ate some gum she was not supposed to and turned into a blueberry that had to be juiced.  Even Charlie stole an Everlasting Gobstopper, but unlike the other children, Charlie felt remorse, and redeemed himself by giving it back to Mr. Wonka.  Bad behavior is often simply that, and cannot be explained away with psychobabble.  As the gold laying geese in the movie teach us, some of us are just bad eggs.   

Jonathan Bellin, LCSW is a member of NEFESH – The International Organization of Orthodox Mental Health Professionals.  He is a child, adolescent, and adult psychotherapist in private practice in Riverdale and is a Supervisor and Field Instructor at the Northside Center for Childhood Development.  Contact him at jonathanbellin7@gmail.com  and visit his website at www.jonathanbellin.com